Healthcare Provider Details

I. General information

NPI: 1578624003
Provider Name (Legal Business Name): MT. WASHINGTON PEDIATRIC HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

IV. Provider business mailing address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8600
  • Fax: 410-578-0567
Mailing address:
  • Phone: 410-578-8600
  • Fax: 410-578-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY MILLER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 410-578-5163